Does flower water harbour potentially deadly bacteria? Do bedside blooms compete with patients for oxygen? Do bouquets pose a health and safety risk around medical equipment?

These are some of the reasons given by many hospital wards in the UK to ban, or at least discourage, bedside bouquets. But is this anxiety justified, and what do patients feel about flower policies?

To find out more, Giskin Day and Naiome Carter of Imperial College London surveyed the literature and talked to patients and staff at the Royal Brompton Hospital and the Chelsea & Westminster Hospital about their attitudes towards flowers. Their findings are published on bmj.com today, as part of the Christmas issue.

A 1973 study found that flower water contained high counts of bacteria. However, subsequent research found no evidence that flower water has ever caused hospital-acquired infection. Yet hospitals continue to prohibit flowers on the ward in the absence of any official ruling from the Department of Health.

Other negative effects have been ascribed to flowers. In the late 1900s it was common to remove flowers from bedsides at night as there was widespread belief that the blooms competed for patients' oxygen. But this was dismissed as a myth when studies showed that the impact of flowers on air composition in wards was negligible and did not justify the labour involved in moving flowers to and fro.

Southend University Hospital recently imposed a blanket ban on flowers on the grounds that they posed a health and safety risk around high tech medical equipment, but it could be argued that flower vases are no more risky than having crockery containing drinks or food around bedsides.

There is some evidence that most nurses are not in favour of flowers, partly because of the amount of work generated. Interviews with staff in this study also suggest that they are more concerned about the practical implications of managing flowers than risks of infection.

Other studies report that flowers have immediate and long term beneficial effects on emotional reactions, mood, social behaviours, and memory for men and women alike. One trial found that patients in hospital rooms with plants and flowers needed significantly fewer postoperative analgesics; had reduced systolic blood pressure and heart rate; lower ratings of pain, anxiety, and fatigue; and had more positive feelings than patients in the control group.

Given that flowers and herbs have been used as remedies in the earliest hospitals, and as a means of cheering up the hospital environment for at least 200 years, it seems remarkable that flowers still tend to be treated in an ad hoc fashion in hospitals, say the authors. Although flowers undoubtedly can be a time consuming nuisance, the giving and receiving of flowers is a culturally important transaction, they conclude.

In an accompanying editorial, Simon Cohn, a medical anthropologist at Cambridge University argues that flowers have fallen victim to new definitions of care.

By David Fewster - Worldwidehealth Editor

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